BACKGROUND Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. METHODS This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. FINDINGS Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1-87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1-74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2-15·5), childhood wasting (9·9% decrease, 9·6-10·2), and low use of oral rehydration solution (6·9% decrease, 4·8-8·4). INTERPRETATION Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. FUNDING Bill & Melinda Gates Foundation.

中文翻译：

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量化影响 5 岁以下儿童腹泻负担的风险和干预措施：2017 年全球疾病负担研究分析。

背景技术 许多国家 5 岁以下儿童的腹泻病死亡率显着下降。通过此分析，我们提供了 2017 年全球疾病负担、伤害和风险因素研究 (GBD 2017) 中 5 岁以下儿童腹泻病死亡率的最新结果，并使用该研究的比较风险评估来量化风险的趋势和影响1990 年至 2017 年间，影响 195 个国家和地区死亡率变化的因素、干预措施和更广泛的社会人口发展。 方法 2017 年 GBD 分析包含三个主要组成部分。使用预测性贝叶斯集成建模工具中的生命登记数据、人口统计监测数据和口头尸检数据对腹泻死亡率进行建模；腹泻的危险因素和干预措施的归因是在反事实框架中建模的，该框架将模型中暴露于每种风险或干预措施的人群水平流行率与暴露于该因素的腹泻相对风险相结合。我们评估了 1990 年至 2017 年间腹泻死亡率的相对和绝对变化，并利用危险因素暴露和社会人口状况的变化来解释 5 岁以下儿童腹泻死亡率趋势的差异。调查结果 2017 年，估计全球 5 岁以下儿童中有 533 768 人因腹泻死亡（95% 不确定性区间为 477 162-593 145），每 10 万人中有 78·4 人死亡 (70·1-87·1)孩子们。不同国家的腹泻死亡率差异很大，每 10 万名儿童中有超过 685 人死亡。1990 年至 2017 年间，全球每 10 万人腹泻死亡率下降了 69·6% (63·1-74·6)。在本研究考虑的风险因素中，导致腹泻死亡率下降幅度最大的是接触环境的减少。不安全的卫生条件（减少 13·3%，11·2-15·5）、儿童消瘦（减少 9·9%，9·6-10·2）以及口服补液盐使用量低（减少 6·9%） ，4·8-8·4)。解释 自 1990 年以来，腹泻死亡率已大幅下降，但各国之间存在差异。社会人口统计指标的改善可能可以解释其中一些趋势，但暴露于危险因素的变化——特别是不安全的卫生条件、儿童生长障碍和口服补液溶液的低使用率——似乎与腹泻死亡率的相对和绝对下降率有关。尽管最有效的干预措施可能因国家或地区而异，但确定和扩大旨在预防和预防腹泻的干预措施已经降低了腹泻死亡率，可以进一步避免数千人死于这种疾病。资助比尔及梅琳达·盖茨基金会。